Kyphosis Symptoms Diagnosis in New Jersey
Kyphosis refers to an excessive forward curvature of the upper back, specifically the thoracic vertebrae near the base of the neck. Some individuals are genetically predisposed to what is commonly referred to as a “hunch back” appearance which becomes evident in teenage years and early adulthood. Kyphosis can also occur later in life to individuals with a medical history of osteoporosis or any other cause of a low bone density which predisposes the vertebrae to fracture. Kyphosis causes neck strain and pain because of the maladaptive stress it places on the neck. If the thoracic vertebrae are severely curved, it reduces the capacity of the lungs which causes difficulty breathing and shortness of breath. Clearly, kyphosis can drastically impact the ability to perform day-to-day activities.
The Centers for Neurosurgery, Spine & Orthopedics (CNSO) medical team consists of board-certified neurosurgeons, orthopedic spine surgeons, and physical therapists with years of successfully treating patients with kyphosis either conservatively or surgically. CNSO can accurately diagnose and provide the right treatment plan to ensure quick relief and normalcy in spine function.
A healthy human spine usually has a slight curvature throughout the neck region (cervical vertebrae) as well as the lower back (lumbar vertebrae) with the arc of the curve anterior in a similar direction. This natural curvature is referred to as lordosis. In the thoracic spine and the sacrum, the arc is posterior and referred to as kyphosis. Like natural lordosis, there’s also natural kyphosis which is considered natural as long as the curvature is within the normal range of degrees of curvature. If the angle of curvature is outside of the range of normal, then depending on the direction of the arc, the excessive angulation would be categorized as either lordotic or kyphotic. Sometimes the malformation is severe enough that it can be diagnosed upon visualization. The doctor will, however, need x-ray imaging to measure the degree of severity and determine a treatment plan.
Signs and Symptoms of Kyphosis
The primary symptom of kyphosis is the appearance of a distinct excessive forward curvature of the thoracic spinal column and the appearance of a hunched back. The thoracic malformation causes the shoulder to appear circled forward. The excessive bend in the spine might not be prominent in early development, but an individual may experience any combination of the following symptoms:
- Neck pain
- Shoulder pain
- Differences in shoulder height
- Stiffness in the upper back
- Head being forward as if one’s leaning forward
- Tight hamstrings muscles (back thigh)
Different Types of Kyphosis
There are three common types of kyphosis. They include:
As the name suggests, postural kyphosis results from poor sitting posture throughout childhood. It’s a flexible type of kyphosis and can improve with aggressive strengthening exercises and posture training.
Structural kyphosis occurs when the thoracic vertebrae have developed a wedge shape. The abnormal shapes of the thoracic vertebrae result from fractures, spine malformations, and spinal cancer.
About 0.4% of the global population develops this type of kyphosis, with equal prevalence rates among males and females. Apart from spine cancer, regular exercising, OTC painkillers, and bracing are known to reverse the symptoms of structural kyphosis. Kyphoplasty, which is a minimally invasive procedure, performed as a same day procedure, can treat vertebral fractures. However, in severe cases, spinal fusion surgery might be the last resort.
Congenital kyphosis is characterized by an abnormal shape in the thoracic vertebrae, diagnosed at birth. The baby is noted to have an abnormal forward curvature on the thoracic region, and as s/he grows, the condition gets more noticeable.
Causes and Risk Factors
The spinal column is comprised of individual vertebras, each with a distinct shape, separated by intervertebral discs, stacked on top of one another which forms the backbone. Whenever the thoracic vertebral shape is altered to a wedged shape, it causes kyphosis. This deformity of the individual vertebrae can be caused by:
- Fractures – When the vertebral bone matrix becomes weakened or injured, it can collapse thereby changing the shape of the vertebrae. This causes a pathologic curvature of the spine if not immediately, then over time.
- Osteoporosis – Results in the loss of bone density which can lead to compressional fractures within the structurally weakened vertebra. Osteoporosis is a condition common in older women or individuals who’ve taken corticosteroids for a long time.
- Scheuermann’s Disease – Also referred to as Scheuermann’s kyphosis, this condition is more likely to occur among young men during a growth spurt they experience before puberty.
- Spine Tumor and cancer therapies – Cancer of the spine can cause the thoracic vertebrae to weaken, making them susceptible to compression fractures. Additionally, cancer treatments like chemotherapy and radiation cancer treatment can also cause kyphosis.
- Disc degeneration – Between the spinal vertebrae are soft, circular discs that cushion the spinal bones. As a person ages, the discs dry out and shrink, and that can worsen already existing kyphosis.
Diagnosis of Kyphosis
A physician should first perform a physical examination to determine the need to proceed onto other diagnostics. They may measure the patient’s height to determine if there has been a decrease in height which may be appreciated with kyphosis. In order to enhance the visualization of any spine curvature throughout the thoracic region, the patient will be asked to bend forward from the waist. This physical examination can detect significant scoliosis as well as kyphosis. The doctor will also perform some neurological tests as well as musculoskeletal tests to determine any nerve pathology, flexibility, reflexes, or muscle strength abnormality.
Following a review of the signs, symptoms, and physical examinations, the doctor may recommend further diagnostics such as:
This diagnostic imaging will reveal the skeleton and other body organs on a thin film. The essence of the test is to show the extent of spinal curvature. A curvature exceeding 40 degrees is regarded as abnormal kyphosis or hyperkyphosis.
MRI and CT scans
Magnetic resonance imaging (MRI) and computerized tomography (CT) scans are used by radiologists and neurosurgeons to examine the spinal nerves, abnormalities, or tumors.
These are physical examinations aimed at detecting any numbness or muscle weakness. Furthermore, compressions in the spine can pinch or irritate the nerves impacting nerve impulses traveling from the spinal cord to the peripheral nervous system (PNS).
Bone Density Tests
The physician can also require a bone density test to detect any signs of lost bone mass within the thoracic spinal region. Continuous compressions fracture and weaken spinal bones, causing them to lose significant mass and density.
Treatment of Kyphosis
The treatment plan will primarily focus on alleviating further spinal curvature in the thoracic region and bringing it to its normal posture where possible. The physician will recommend a particular treatment based on the type and severity of kyphosis.
Non-surgical treatment options include:
Physical Therapy and Exercise
For mild kyphosis, your doctor will likely prescribe physical therapy. Through proper stretching, strengthening and conditioning, an exercise-based therapy will improve the kyphosis via strengthening the core and back extensor muscles. It also helps in maintaining a normal posture and reduces or eliminates any associated pain.
Over-the-counter (OTC) drugs
Some OTC drugs help to relieve the pain associated with kyphosis. Naproxen (Aleve), Acetaminophen (Tylenol), and ibuprofen (Advil/Motrin IB) are examples of pain-relieving drugs your doctor might prescribe but should only be used temporarily until the root cause of the pain is resolved.
Calcium and Vitamin D Supplements
Patients with kyphosis resulting from a family history of osteoporosis are often prescribed calcium and Vitamin D supplements to help in strengthening the thoracic vertebrae and increasing bone mass.
A supraclavicular brace, commonly known as a Milwaukee brace, is used in correcting kyphosis among growing children. A CNSO neurosurgeon or orthopedic spine doctor will first diagnose the condition and then prescribe the necessary treatment course. Bracing is often recommended for children when the spinal curvature is greater than 60 degrees. In this situation, a brace would be fabricated based on the individual patient and according to the surgeon’s specifications. In order to avoid surgery, the patient would need to wear the brace 23 hours a day until they are past adolescents.
People with severe kyphosis, whether postural, congenital, injury, fractures, or disease, may not positively respond to non-surgical treatment methods. When severe, a spinal fusion surgery will be necessary.
A spinal fusion may be completed in one day with the patient discharged at night. The more extensive the spinal fusion, the more likely the patient will need to spend one to two nights in the hospital.
CNSO uses real-time X-ray imaging (fluoroscopy) during the operation along with intraoperative nerve monitoring to ensure the proper maintenance of the spinal cord and its functioning throughout the case. Electrodes are placed on the patient’s head and limbs at the start of the operation to continuously measure electronic signals back and forth.
Positioning of support constructs secured by titanium medical screws corrects kyphosis. It’s a delicate surgery which should only be performed by neurosurgeons or orthopedic spine surgeons in order to successfully correct the abnormal curvature of the spine. Depending on the extent of the kyphotic correction, the operation may take between three to six hours. The recovery time may be up to six weeks.
Contact the Specialists of CNSO in New Jersey
Kyphosis is a condition that causes neck pain and shoulder pain. It may also cause shortness of breath and difficulty functioning. Fortunately, kyphosis is a treatable spinal problem but it requires immediate medical attention.
For those that may have kyphosis, request an appointment with Centers for Neurosurgery, Spine & Orthopedics, and talk to one of the qualified and experienced neurosurgeons or orthopedic spine surgeons in Northern New Jersey. The CNSO surgeons will provide a comprehensive and patient-centered treatment plan.